Broquetas Joan Maria, Pedreny Roser, Martínez-Llorens Juana María, Sellarésa Jacobo, Gea Joaquim
Servicio de Neumología, Hospital del Mar-IMIM, Barcelona, España.
Arch Bronconeumol. 2008 May;44(5):252-6. doi: 10.1016/s1579-2129(08)60040-3.
The current pressure on conventional inpatient care units represents a very serious problem for respiratory medicine departments. The aim of this study was to analyze the impact of a new instrument --a short-stay respiratory unit-- on the quality of care delivered by the respiratory medicine department of a tertiary care hospital.
The short-stay respiratory unit consisted of 4 conventional hospital beds managed by a pulmonologist. The beds were only used to treat patients diagnosed with exacerbation of chronic obstructive pulmonary disease or bronchial asthma, community-acquired pneumonia, or suspected lung cancer, and stays were intended to only last for up less than to 4 days. Analyzing a range of healthcare quality variables, we compared the quality of care delivered during the first 6 months the unit was in operation (October 2005 to March 2006) to that delivered in the same period 12 months earlier.
The study included 147 patients admitted to the short-stay unit. The mean (SD) age of the patients was 64 (17) years and 79% were men. The mean length of stay was 3.3 (1.6) days--only 1.4% of patients stayed for longer than 4 days--and the readmission rate was 2.7%. There were no deaths. The existence of the short-stay respiratory unit led to a 30% decrease in the overall mean length of stay in the respiratory medicine department (11.8 [4.6] vs 8.3 [2.6] days; P< .001), and the readmission rate fell from 21% to 15% (P< .05). While there were no differences in mortality between the 2 periods, the complexity of diseases treated by the respiratory medicine department showed an increase of 9.2% (P< .001).
A short-stay respiratory unit can improve the efficiency of care delivered by a respiratory medicine department by reducing both the mean duration of hospitalization and the readmission rate, without a reduction in the complexity of diseases treated or a need for additional resources.
传统住院护理单元目前面临的压力对呼吸内科来说是一个非常严重的问题。本研究的目的是分析一种新工具——短期呼吸护理单元——对一家三级医院呼吸内科所提供护理质量的影响。
短期呼吸护理单元由4张传统医院病床组成，由一名肺科医生管理。这些病床仅用于治疗被诊断为慢性阻塞性肺疾病或支气管哮喘急性加重、社区获得性肺炎或疑似肺癌的患者，住院时间预计不超过4天。通过分析一系列医疗质量变量，我们将该单元运行的前6个月（2005年10月至2006年3月）所提供的护理质量与12个月前同期所提供的护理质量进行了比较。
该研究纳入了147名入住短期护理单元的患者。患者的平均（标准差）年龄为64（17）岁，79%为男性。平均住院时间为3.3（1.6）天——只有1.4%的患者住院时间超过4天——再入院率为2.7%。无死亡病例。短期呼吸护理单元的设立使呼吸内科的总体平均住院时间减少了30%（11.8 [4.6]天对8.3 [2.6]天；P <.001），再入院率从21%降至15%（P <.05）。虽然两个时期的死亡率没有差异，但呼吸内科治疗的疾病复杂性增加了9.2%（P <.001）。
短期呼吸护理单元可以通过缩短平均住院时间和再入院率来提高呼吸内科的护理效率，而不会降低所治疗疾病的复杂性或需要额外的资源。
